E-cigarettes could hook new generation on nicotine, medical journal warns

TORONTO - A leading Canadian medical journal is raising concerns that electronic cigarettes could hook a new generation into nicotine addiction.

With fruit-flavoured products and movie star endorsements, e-cigarettes could lure youth who wouldn't otherwise smoke into a nicotine habit, an editorial in this week's issue of the Canadian Medical Association Journal suggests.

The editorial was written by Dr. Matthew Stanbrook, a Toronto-based respirologist and an editor at the journal.

He said it may be tempting for society to embrace e-cigarettes based on the assumption that they help some people to quit smoking. But he warned that some people use e-cigarettes to get a nicotine hit where they are not allowed to smoke and continue to smoke regular cigarettes as well.

"It isn't as obviously a good thing as those trying to sell these are trying to make it appear to be," Stanbrook said in an interview.

"You would think: 'Well, here's a cigarette that doesn't have all the bad stuff. How could that be bad?' But you have to think beyond an e-cigarette versus a regular cigarette and think about how this is going to change the behaviour of smokers. And that's the concern."

Electronic cigarettes are small cigarette-shaped canisters that are used to simulate the sensation of smoking. Batteries in the canisters heat up fluid-filled cartridges that then give off a vapour, which from a distance resembles smoke.

Some of the cartridges are filled with flavoured liquids, for example cherry or menthol. Others contain nicotine, though those are not meant to be sold in Canada.

Under Canadian law, it is illegal to sell e-cigarettes with nicotine. Still, vials of nicotine for e-cigarettes can be purchased in the U.S. or ordered over the Internet. Canadian border authorities will seize shipments of nicotine vials for e-cigarettes — when they spot them.

One of Stanbrook's major concerns is that increasing use of e-cigarettes could undermine the tool he credits most for having driven down smoking rates in Canada — the restrictions on smoking in workplaces, in restaurants and bars and many other public settings. These policies have made it harder for smokers to smoke, and have turned public perception against the habit.

"It was to make it more and more inconvenient to continue their addiction so that they were finally motivated to quit, as the overwhelming majority of smokers want to do anyway but can't," said Stanbrook, who practises at Toronto Western Hospital.

"So anything that reverses that most effective tool we've ever invented is of concern."

Stanbrook acknowledged that e-cigarettes probably do help some people quit smoking. But he worries that — unlike nicotine patches or gum — the devices have a cool quotient that could appeal to youth and spur them to start consuming nicotine.

"The gum isn't cool for youth to use in clubs. No one's going to make that sexy. No one's going to make sticking a nicotine patch on sexy and trendy. But here's something that looks to a casual observer exactly like smoking, can be made trendy, can be expanded to people who never smoked. That's where the concern comes in."

The editorial comes as the Canadian Cancer Society calls on federal and provincial governments to ban all flavoured tobacco products.

Data from the national Youth Smoking Survey, released Monday, showed that more than half of high school students in Canada who used tobacco products in the previous 30 days reported having used flavoured tobacco products.

While the federal Tobacco Act bars the use of flavours — except menthol — in cigarettes, cigarillos and blunt wraps (flavoured rolling papers), there are ways around the ban, the society said in a release.

For instance, the act defines cigarillos as weighing 1.4 grams or less. Some tobacco companies have produced flavoured cigarillos that weigh more than 1.4 g, thereby sidestepping the regulation. As well, there is no prohibition on flavouring tobacco used in water pipes or adding flavours to smokeless tobacco — products like snuff, chewing tobacco and snus.

The Youth Smoking Survey found that among high school students, 14 per cent had smoked cigarettes in the previous 30 days, 20 per cent had used a tobacco product in the previous 30 days and 10 per cent had used a flavoured tobacco product (including menthol cigarettes) in the previous 30 days.

"Swift action is needed to protect youth from these products. It is essential that governments introduce new legislation without delay," said Rob Cunningham, senior policy analyst for the Canadian Cancer Society.